Italy: Hyper-Regulation of Abortion Care

Congratulations and thanks to Dr. Elena Caruso, whose article on “The Hyper-Regulation of Abortion Care in Italy” was recently published in the International Journal of Gynecology and Obstetrics‘ “Ethical and Legal Issues in Reproductive Health” section, edited by Professors Rebecca J. Cook, Bernard M. Dickens and Charles G. Ngwena. The author, Elena Caruso, is an Italian legal scholar who completed a doctorate in Law at Kent University and who now holds an AMTD Waterloo Global Talent Postdoctoral Fellowship at the University of Waterloo in Ontario, Canada. We are pleased to circulate the following abstract of this article, which is now fully available online in both English and Italian:

The Hyper-Regulation of Abortion Care in Italy, by Elena Caruso in International Journal of Gynecology and Obstetrics 163.3 (December 2023):1036-1042.  PDF at Wiley Online.  Italian translation.

ABSTRACT: This paper argues that the current abortion regulation by Law 194/1978 is an inadequate basis for the provision of good quality abortion care and must be reformed. First, the paper explains why Law 194/1978 creates a hyper-regulatory regime that is inconsistent with the best clinical evidence and practices in the field as well as relevant international human rights law, as outlined in the World Health Organization’s (WHO) 2022 Abortion Care Guideline. Second, it highlights gaps between what the law says and what happens in practice, pointing out how the everyday life of Law 194/1978, especially in the practices of gynecologists, is far removed from international standards of quality abortion care and has yet to comply with international human rights law. Third, it sets out some alternative routes to abortion access “outside” Law 194/1978. Finally, it concludes with some suggestions for a change in the practice of gynecology and a call for the reform of Law 194/1978, in favor of a bodily autonomy model of regulation grounded on decriminalization, demedicalization, dehospitalization, and self-management to ensure compliance with the WHO standards and international human rights law.

The entire paper is now freely available in English and Italian: English article PDF.  Italian translation.

RELEVANT RESOURCES:

Law 194 of 1978: an English translation of this Italian law is online here.

The WHO Abortion Care Guideline: Law and Policy–Past, Present and Future,” by Joanna N. Erdman, in International Journal of Gynecology and Obstetrics162.3 (Sept 2023): 1119–1124.   PDF at Wiley Online. 

Abortion Law Decisions webpages, now updated in English and in Spanish.

Ethical and Legal Issues in Reproductive Health – more than 110 other concise articles are online here.
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Contributed by: The International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.   See Program website for our Publications,  Research resources, and Reprohealthlaw Commentaries Series.  TO JOIN THE REPROHEALTHLAW BLOG: enter your email address in the upper right corner of this blog, then check your email to confirm the subscription.

India: Reimagining Reproductive Rights Jurisprudence

Congratulations to Dipika Jain and Payal Shah, whose 2020 article recently appeared in the Columbia Journal of Gender and Law. Dipika Jain is a Professor of Law and Executive Director of the Centre for Health Law, Ethics, and Technology at Jindal Global Law School. Payal K. Shah, recently acting as Regional Director for Asia at the Center for Reproductive Rights, is now a Reproductive Health Law Fellow in the International Reproductive and Sexual Health Law Program at the University of Toronto’s Faculty of Law. We are pleased to circulate the authors’ abstract and a link to their paper:

“Reimagining Reproductive Rights Jurisprudence in India: Reflections on the Recent Decisions on Privacy and Gender Equality from the Supreme Court of India,” by Dipika Jain and Payal K. Shah. Columbia Journal of Gender and Law 39.2 (2020): 1-53. Abstract and article online.

Despite the significant impact of decisions around pregnancy, including abortion, on a woman’s future life and enjoyment of her other human rights, the Indian judiciary has yet to clearly articulate the link between reproductive autonomy and gender equality. In the Puttaswamy decision, the Supreme Court’s recognition of the right to reproductive choice is rooted within the constitutionally protected right to privacy. While the right to privacy has been the basis for ground-breaking judgments on reproductive rights globally, feminist legal theorists have voiced significant critiques as to the limits of privacy, specifically its potential to achieve reproductive autonomy and equality. We explore the applicability of these critiques in India, including concerns voiced by legal scholars regarding the limitations of the right to privacy as a tool for meaningful enjoyment of reproductive autonomy or gender equality as a whole.

The post-Puttaswamy decisions of Navtej Johar [on homosexuality] and Joseph Shine [on adultery] mark a shift in jurisprudence, with the Supreme Court relying on equality-based arguments to reject societal stigmatization and discrimination against the marginalized group in question. In both cases, the court set forth a framework to understand how the rights to privacy, equality, and non-discrimination on the basis of sex and gender intersect. This intersection of rights gives rise to an obligation of states to eliminate laws that reflect discriminatory gender stereotypes, including those pertaining to sexuality. Limits on the right to abortion indirectly or directly marginalize women by controlling their right to bodily autonomy and denying them privacy and equality. Hence, we argue that these cases demonstrate the potential success of arguments for reproductive rights based on equal citizenship.

We first lay out the legal framework and jurisprudence of reproductive rights in India before the Puttaswamy decision. We then explore the benefits of having a constitutionally recognized right to privacy and how it can advance reproductive rights. We also examine the drawbacks of using a privacy-based analysis as a foundation for reproductive rights due to its vulnerability to restriction on grounds of compelling state interest. Further, this we engage with feminist critiques of privacy rights as well as equality-based approaches and argue for a framework that takes into consideration meaningful choice and structural barriers to the exercise of reproductive autonomy. We critically examine judgments from comparative and international law that have a strong basis in the right to equality to reflect on how recognition of reproductive rights as an issue of gender justice—beyond just individual choice—could strengthen Indian reproductive rights jurisprudence. In other words, we argue for a reimagination of reproductive rights within an equality framework. Finally, we conclude that the use of an equality-based framework could significantly benefit pregnant persons’ right to reproductive autonomy.

The full text can be freely downloaded through this webpage.]

RELATED REPORTS by Payal K. Shah:

Securing Reproductive Justice in India: A Casebook, Center for Reproductive Rights, 2019 (co-authored with Mrinal Satish and Aparna Chandra) 520-page casebook, and chapters by topic.

Ensuring Reproductive Rights: Reform to Address Women’s and Girls’ Need for Abortion After 20 Weeks in India, Center for Reproductive Rights, 2018. 56-page report.

Reproductive Rights in Indian Courts, Center for Reproductive Rights, 2016. 4-page briefing.
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Compiled by: the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca.   See Program website for our Publications,  Information Resources, and Reprohealthlaw Commentaries Series.  TO JOIN THE REPROHEALTHLAW BLOG: enter your email address in the upper right corner of our blog, then check your email to confirm the subscription.

Reproductive Autonomy of Women and Girls under the Disabilities Convention

Congratulations to Prof. Charles Ngwena of the Centre for Human Rights, Faculty of Law, University of Pretoria, South Africa, whose valuable article has recently been published in the Ethical and Legal Issues section of the International Journal of Gynecology and Obstetrics. We are pleased to circulate the following abstract:

“Reproductive Autonomy of Women and Girls under the Convention on the Rights of Persons with Disabilities,”  by Prof. Charles Ngwena, International Journal of Gynecology and Obstetrics, 140.1 (Jan. 2018):128-133.  PDF online for 12 months.          Submitted text at SSRN

Women and girls with disabilities have historically been denied the freedom to make their own choices in matters relating to their reproduction. In the healthcare sector they experience multiple discriminatory practices. Women and girls with intellectual disabilities are particularly vulnerable to coerced or forced medical interventions. The present article considers the contribution the Convention on the Rights of Persons with Disabilities makes towards affirming the rights of women and girls with disabilities to enjoy reproductive autonomy, including autonomy related to reproductivehealth, on an equal basis with individuals without disabilities. The Convention is paradigm-setting in its maximal approach to affirming the rights of  individuals with disabilities to make autonomous choices under conditions of equality and non-discrimination.  The Convention is the first human rights treaty to clearly affirm that impairment of decision-making skills is not a justification for depriving a person with cognitive or intellectual disability of legal capacity.

Key words: Abortion; Disability; Equality; Legal capacity; Non-discrimination; Reasonable accommodation; Reproductive autonomy; Reproductive health

The published article is online in PDF at Wiley Library.
Full text, as submitted, is online at SSRN.
Ethical and Legal Issues in Reproductive Health: 80 other concise articles.

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Compiled by the Coordinator of the International Reproductive and Sexual Health Law Program, reprohealth*law at utoronto.ca For Program publications and resources, see our website, online here. TO JOIN THIS BLOG: enter your email address in upper right corner of this webpage, then check your email to confirm the subscription.

Abortion by Telemedicine in Northern Ireland: Patient and Professional Rights Across Borders

Congratulations to Professors Tamara K. Hervey of the University of Sheffield’s Faculty of Law, and Sally Sheldon of Kent Law School, whose insightful article was recently published in the Northern Ireland Legal Quarterly.  We thank them for putting their submitted text online, with the publisher’s permission: .

Tamara K. Hervey and Sally Sheldon, “Abortion by Telemedicine in Northern Ireland: Patient and Professional Rights Across Borders,” (2017) 68(1) NILQ 1-33.  Article in NILQ.       Submitted Text online at SSRN.

Abstract

The uneasy legal and political settlement regarding abortion in Northern Ireland has long relied on the outsourcing of aspects of reproductive health care. While local health services offer only highly restricted access to termination procedures, women travel to access abortion services elsewhere. However, technological changes, in particular the development of abortifacient medicines, are revolutionising this aspect of reproductive healthcare. Rather than women having to travel to a service, today that service can travel to women through the postal supply of abortion pills, sourced via the internet. While online supply of pharmaceuticals can pose potential public health risks, at least two groups offer safe and effective telemedical services to women in Northern Ireland. Women on Web and Women Help Women each supply abortion pills, under prescription from a doctor based in another country, to women who wish to end a pregnancy of nine weeks or less. Here, we consider the extent to which the telemedical abortion services that they offer are protected by transnational law, in particular, EU provisions on cross-border services. This offers new and hitherto unexplored lines of legal argument (including defences against criminal prosecution and challenges to a state’s attempts to restrict the flow of services). Through claiming the autonomy-based legal relationships implicit in transnational law and the power that flows therefrom, we suggest, women may challenge regulatory arrangements which seek to limit their reproductive rights.

For full text, see:   Article in NILQ.       Submitted Text online at SSRN.

Body Politics: Criminalization of sexuality and reproduction – Amnesty’s new primer

Congratulations to Amnesty International’s Criminalization of Sexuality and Reproduction Project Team for this useful new reference book:

Body Politics: Criminalization of sexuality and reproduction. (London: Amnesty International, 2018) 220 pages.  PDF online.

This book “aims to motivate and equip the organization’s global movement to challenge unjust criminalization of sexuality and reproduction in local, national, regional and international contexts.”  It is part of an Amnesty International series, which includes this Primer, a Toolkit and a forthcoming Training Manual (see links below).
As noted in the Introduction, “This Primer gives an overview of sexual and reproductive rights that states must respect, protect and fulfil and how states punish and prevent people from exercising these rights. . . . [It] looks at these issues from a human rights perspective, in particular through the lens of “bodily autonomy” – the entitlement to decide what we do with our bodies, what we allow, desire and/or forbid others to do with our bodies, and to make essential decisions about our bodies. The Primer includes discussion of seven issue areas where overreaching laws and policies criminalize sexual and reproductive actions, decisions and gender expression thereby violating our bodily autonomy and denying us our dignity and human rights.” (p.19)  The seven focus issues are:   Criminalizing pregnancy, abortion, adolescent sexual activity, same-sex sexual activity, sex outside marriage and sex work, as well as HIV non-disclosure, exposure and transmission. The book also contains a useful glossary.
As Anand Grover comments: “Amnesty International’s Primer and Toolkit – Body Politics: Criminalization of sexuality and reproduction – is a timely, meaningful and welcome contribution that can enable activists to both comprehend and challenge illegitimate criminalization of sexuality and reproductive decisions. It is vital to understand the extent to which criminalization has permeated states today and the damage which is done by such measures masquerading as legitimate public health or public morality initiatives. This Primer details the major areas of concern and the harm which both direct and indirect criminalization inflict on an individual’s human rights and the health of society as a whole. It is not enough, however, to simply understand the problem of criminalization of sexuality and reproductive decisions; steps must also be taken to challenge it. The Toolkit provides concrete campaigning techniques such as mapping stakeholder participation and power, identifying advocacy targets, and building capacity. The [forthcoming] Training Manual can be used to build understanding and capacity around these issues for a range of audiences and activists.”  (p. 9, our emphases)

“Body Politics: Criminalization of sexuality and reproduction”
220-page Primer
See also:  Toolkit:  38-page PDF
Rationale for this Amnesty International’s campaign  is explained here.

Constitutional Developments in Latin American Abortion Law

Congratulations to two Argentine scholars,  Paola Bergallo and Agustina Ramón Michel, who recently co-authored a useful article in the Legal and Ethical Issues section of the International Journal of Gynecology and Obstetrics.

Paola Bergallo and Agustina Ramón Michel, “Constitutional Developments in Latin American Abortion Law,”  International Journal of Gynecology and Obstetrics 135 (2016) 228–231.   PDF online here.

Abstract: For most of the 20th century, restrictive abortion laws were in place in continental Latin America. In recent years, reforms have caused a liberalizing shift, supported by constitutional decisions of the countries’ high courts. The present article offers an overview of the turn toward more liberal rules and the resolution of abortion disputes by reference to national constitutions. For such purpose, the main legal changes of abortion laws in the last decade are first surveyed. Landmark decisions of the high courts of Argentina, Bolivia, Colombia, and Mexico are then analyzed. It is shown that courts have accepted the need to balance interests and competing rights to ground less restrictive laws. In doing so, they have articulated limits to protection of fetal interests, and basic ideas of women’s dignity, autonomy, and equality. The process of constitutionalization has only just begun. Constitutional judgments are not the last word, but they are important contributions in reinforcing the legality of abortion.   Full text online through SSRN

Further reading
(English):
“Abortion,” by Paola Bergallo & Agustina Ramón Michel, Chapter 3 in  The Latin American casebook: Courts, constitutions and rights, ed. Juan F. Gonzalez-Bertomeu and Roberto Gargarella (Routledge, 2016).  Latin American casebook .

“The Constititutionalization of Abortion,” by Reva Siegel, in Abortion Law in Transnational Perspective: Cases and Controversies (University of Pennsylvania Press, 2014) 13-35.  English book.  Libro en español.

(Spanish):
“La constitucionalización del aborto y sus encuadres en las altas cortes de América Latina,” por Paola Bergallo & Agustina Ramón Michel, “constitucionalización,” Academia.edu.

“Interpretando derechos: La otra legalización del aborto en América Latina.” por Paola Bergallo, Capitulo 7 en Debates y Reflexiones en torno a la despenalización del aborto en Chile, Lidia Casas y Delfina Lawson. Ediciones Lon, Santiago de Chile, 2016. “Interpretando”, Academia.edu.    Debates y Reflexiones – PDF Book .

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